Anyone ever move a loved one on Medicaid to another State?

Saya_G

My sister’s nursing home has asked us to move her. They are citing that she is “exit seeking” and that she is difficult to deal with - saying that she needs to be in a memory care wings. They do not offer the service.

I suspect that is not the true reason - yes, she is difficult, and she is an exit seeker (5-6 times a day she sets of their alarms). Still, I think my insistence that she an outside doctor for a wound that will not heal, and other issues that we’ve had over the years are more the issue. That said, I know I have the right to have her see outside doctors, and the other issues would not be acceptable reasons to ask her to move! But we’re still having to move her - which might be good ultimately, but right now it’s a big mess.

All that said, at this point we just need to find a new facility. We have decided to move her to another State (moving from TX to our home State NE).

My question is, what pit falls should we watch out for?

BTW… she is on Medicaid, and would need to be Medicaid pending in NE.

thanks in advance for any input.

Saya_G

Victoriaredux

I was in a SKN for a few weeks and they had a number of mobile dementia patients . The alarms are so loud -I was in the room next to the receptionist area and the alarms went off in the back. Then some PWD would try to get into my room — they said they couldn't do a thing about him - he has rights —so they fenced me and my roommate in with a bright orange rope fence - like you see at traffic construction zones. I said I can't unhook that thing if something happens. "We'll try to get to you. " I wasn't reassured.

You can ask for help with her discharge - maybe buy more time? - see : video at 11 :41

It's very technical but a free service from CMS Medicare - the "service dates" is important

https://alzconnected.org/discussion/71187/medicare-discharge-observation-status-representative-status-advise-help-video

JJ401

Maybe this link will help.

https://www.medicaidlongtermcare.org/how-to-apply/transfer-state-to-state/

harshedbuzz

@Saya_G

I think NE is one of those states where Medicaid doesn't fund Memory Care. She'd not only have to be admitted Medicaid-pending, she'd need to be deemed as requiring skilled nursing. I considered moving my parents across the river to NJ for this reason when dad was diagnosed.

Memory Care in Nebraska | MemoryCare.com

HB

Saya_G

Thanks for the info it helped a lot.

I was surprised to see that NE's income max is very low ($1255)! TX's is $2829. My sister makes nowhere near the TX limit, but is just over $200 on the NE limit. Since we can't change the amount of her SS check, we need to focus elsewhere.

We were/ are looking for a nursing home with a Memory care wing.

We will now focus on Western Iowa; or she has to remain in TX. Since I already have burnout, have had for several years, changing focus back to remaining in TX is hard. But I guess God has a plan, and I just need to focus on that for now.

Problem is we are on a timeline.

:/

MN Chickadee

Looks like Nebraska is a waiver program for memory care. It covers some services, the actual caregiving/medical part, but not room and board unless the person requires a skilled nursing facility. You will want to contact the Nebraska DHHS assistance office and perhaps also an elder law attorney in NE to get a good handle on what she will qualify for. It sounds like the facility is probably right; if she is exit seeking that much then assisted living is not appropriate for her and she needs MC. Good luck with the move; they are never easy and I remember she's already difficult to please.

harshedbuzz

@Saya_G

If NE would be better for you, perhaps speaking with an elder law attorney in NE might bring some clarity. Sometimes funds can be put into a trust that pays a portion of the facility's monthly charge with Medicaid picking up the rest. You can't know until you've consulted an in-state expert in the field.

HB

Saya_G

so, what if no one will take her? I can’t take her 24/7. I can’t lift her, she’s wheelchair bound, is incontinent, she has open wounds that don’t seem to want to heal (her feet and butt - pressure wounds on the butt); she refuses to let them do cat scans or other medical tests that might help them with determining why her wounds won’t heal, I have no place to bath her or a bedroom to put her in at home. I’m near 70, I just can’t do it. Besides that I honestly do not want to, I want to enjoy the years I have left - the past 10 have been taking care of my mother and sister ( my mother passed in January - she was so much easier than my sister). Since my mom passed my sister’s behavioral issues have intensified. Maybe because she feels alone. That said, she refuses to make friends or join in on activities at the nursing home.

I get why they are fed up with her - she is a handful - fights them with every move. She locks her body when they try to get her out of her chair to change her depends (hence why the pressure wounds not healing); it takes several CNAs to change her. It’s the same for baths and bed time. Her only thought is that she wants to go home. She asks me to take her with me every time I leave. I’m told she asks staff to take her with them when they leave for the day.

The social worker says she’s now hitting people. I’m not sure that she actually doubling up her fists and hitting them, but she does push and flail her arms when they try to move her out of her chair for needed care. And, she does cuss them out and threaten to hit them when they try to move her.

so I know her clinicals that her present nursing home sends prospective homes could cause them not to accept her.

So what if that happens? What options for placement will she have?

BTW… my brother has an appointment with the folks in NE to see if there is some sort of why she can still be accept to move there - but the reality is probably not. :/

Victoriaredux

Please call the CMS qio for your state. [the article I posted above ] .

Saya_G

I will, if needed. I’m hoping she’s accepted at another nursing home (I’ve put in applications at four - all with memory care wings.)

I should know within a few days. If she’s turned down, I’ll call the QIO. That said, forcing the nursing home to keep her isn’t going to make it better for her. No one should to stay where they are not wanted. In the end, they will eventually be able to get her out - what happens then? That’s my question.

I’m asking if there are facilities that take difficult folks with dementia - I’d rather we didn’t have to go that direction. But I want to have a heads up on what’s available.

If there are behavioral issue facilities, what are they like?

Victoriaredux

"are (there) facilities that take difficult folks with dementia" Yes, they are called geripsych units, where they can adjust her meds to hopefully calm her behaviors —you've got the overlay that she also needs wound care.

The geripsych beds are in demand so I don't know how long they'd be able to keep her after her meds are adjusted — you have been given a discharge date - and being medicaid you need to know what the options are — ideally she'd be able to get a stay in a psych unit to get behaviors adjusted and then back to the SKN to get the wounds addressed. After they heal , if her behaviors are better then you'd be looking for a medicaid memory care bed.

Time frames matter , the qio's are no charge and discharges are what they do. Not waiting to get their no cost advise couldn't hurt.

Are you her court appointed guardian or hold her activated dpoa/AHCD?

Saya_G

https://alzconnected.org/discussion/comment/228729#Comment_228729

I have both a durable and medical POA. I do not want Guardianship - I’ve heard that comes with financial responsibility, which I just can’t take on. I do not have an AHCD either.

Would the geripsych unit be the next option for someone that can’t be placed due to behavioral issues?

I had heard that memory care wings took more demanding folks with dementia, but I’ve been surprised to heard that is not the case (which is what the folks at my sisters nursing home have said).

Victoriaredux

This post may help explain :

https://alzconnected.org/discussion/65968/extremely-combative-dementia-patient-help

click the View post to see all the replies. Jo C 's is , as always, very complete .

housefinch

I think the wound care would be a possible barrier to some Geripsych units accepting her for admission. It’s possible that a Geripsych unit affiliated with (on same campus as) a university hospital would accept her, because they might have access to a wound care nurse through either Plastic Surgery or Burn departments in the university hospital. I mean a large academic medical center that is affiliated with a medical school. Just an idea if other Geripsych units refuse to accept someone with those medical issues. Academic centers often take the most challenging patients, so another reason to consider one if available in your area. I’m sorry you’re facing this situation.

Saya_G

https://alzconnected.org/discussion/comment/228745#Comment_228745

thank you so much! You’ve been very helpful. I’m not sure where we’ll be going from this, but I have a better understanding of where to find help, and what might need to happen to get aggressive behavior better in line.

Saya_G

Housefinch,

Another factor to consider! Thank you for pointing out a possible problem. I’ll keep it in mind if we have to go that route.

harshedbuzz

@Saya_G

I live in a medically well-served area. I also had many options for memory care for dad. YMMV.

I toured a dozen places for dad. What I found is that there are many lovely MCFs in my community that cherry-pick their residents for the pleasantly befuddled, but only a few who will take more challenging folks. Many places won't accept patients with FTD or younger men because of the potential for "behaviors"; dad wasn't accepted at mom's first choice because his specific diagnosis has a reputation for the same. FWIW, many of the places I toured had keypad doors rather than wander alarms, so exit seeking wasn't something they were overly concerned about.

Most of the cherry-pickers don't accept Medicaid, so they were off the table for my purposes. I got the best information from my local support group about which facilities could and would accept residents who might be deemed challenging by others. If your mom were admitted to a geripsych unit, the social worker there should help get her placed into an appropriate facility.

HB

MN Chickadee

It sounds like she needs geri-psych and med adjustment to get her behavior under control. She may not be accepted in any facility in her current state, but they cannot make you take care of her. Your response to any facility or hospital is "I cannot care for her." They can't make you. I'd definitely be looking to get her into a geri-psych one way or another so that you find the right meds to make care possible. It would also improve her quality of life, as it sounds like she is miserable and could have better living through chemistry. You would then work with geri-psych to find placement. With the wound piece she may require a skilled nursing facility, which may change the Medicaid piece. My first calls would be to her doctor to figure out admission to Geri psych, and an elder law attorney to figure out medicaid after the move. If you have to get her out of the current facility soon, is it an option to do geri-psych in her current location and a move to memory care or a SNF in Texas, and then work on a move to Nebraska down the road? It sounds like a lot to put the move to NE medicaid together at the same time as getting her accepted somewhere, maybe break it into two phases.

Saya_G

surprising news, my sister has been accepted by a facility with a memory care until that is only 30 miles away. This facility was hit by a tornado three years ago, and was rebuilt. Pre tornado, the reviews were 4 1/2 stars! Same owner and manager.

I was concerned with what her clinicals might say after all the complaining by her present facility - apparently her clinicals weren’t as bad as I thought they’d be. She was actually approved by two! The other was older, 45 miles away and their memory care unit was over flowing compared to staff. I considered them, because I didn’t see any other option, but was then told about the reopening of the other facility.

The reopened facility’s memory care has only 10 residents, and their CNAs have has special training to communicate with people with dementia. Actually two residents from the 45 mile away until are transferring into the newly reopened unit! They literally reopened this past Thursday and are already close to full!

Timing is everything.

Still I know there will be adjustments to make, and my sister is going to feel out of place for a while. But this is truly the best situation that could have happened under our circumstances!

on another note, one of my other sister’s (I have three, the oldest the one with dementia, the one I’m about to tell you about is the youngest), was diagnosed with terminal, stage 4 lung cancer this past Sunday. She had no warning that she had an issue until literal days before her diagnoses. They call lung cancer the silent killer for a reason. So this has been an especially hard week, and it looks like the next year ( hopefully years) for my sister are going to be rough - but we’ll be happy to have her as long as we can. Prayers appreciated.

Final note, my brother is still working on a NE move, he’s appealing with the powers that be, but that’ll take time. The move to NE is important because as I get older my plan has always been to move home myself. I’m all my sister with dementia has here in TX - so her remaining here greatly affects my retirement options as well.

Thanks for all your help! I truly cannot tell you how much your support and advice mean to me!

Saya_G